Pricing and Estimates
The best way to get information about the estimated cost of your care is to contact us at SelfPayInquiry@bmc.org and we will respond in 3-5 business days.
In response to the Centers for Medicare & Medicaid’s Price Transparency Rule, we have published all of our services, prices, and contracted rates in a machine readable format.
Additionally, if you are an existing or prospective patient, you can enter your insurance information (or self-pay) in the file below to see a range of costs for a specific service. This tool includes historical rates for all of our procedures, so individual circumstances may vary and is not a guarantee of coverage or out of pocket expenses. Please see the disclaimer section below, and as always, the best way to get information about an estimate is to contact the Patient Financial Services department at SelfPayInquiry@bmc.org.
- Download Outpatient Pricing (17mb)
- Download Inpatient Pricing (5mb)
Follow the instructions within the “Instructions” tab and if you need any assistance please reach out to us at SelfPayInquiry@bmc.org.
Updated May 2022
- Download a list of standard charges for each billable hospital service or item (chargemaster)
- Download a list of the standard Medicare charges for each diagnosis related group (DRG)
CMS requires hospitals to post this information, but please take note that these tools are for informational purposes and do not necessarily provide a patient with an estimate of out-of-pocket costs because:
- Costs will vary based on patients' individual health circumstances – including other relevant health conditions, how long the services take to perform, and what medications are required.
- These lists reflect hospital charges, and do not include charges for services provided by doctors and other providers (professional fees).
- These amounts change frequently.
- Patients may be eligible for financial assistance.
Your health plan can also help you to understand your insurance coverage, which charges will be covered, how much you will be billed, information on deductibles and your expected out-of-pocket responsibility.
Below is a snapshot of information on the Instructions Tab for Download Outpatient Pricing and Download Inpatient Pricing
- Select your insurance carrier from the “Insurance Carrier” field – BMCHP, Harvard Pilgrim
- Then select your individual product from the “Insurance Plan” field – HMO, PPO
- Lastly, pick the DRG associated with the service to which you are inquiring. If you do not know your DRG, please reach out to your insurance provider for assistance.
- Once you pick your DRG, the tool will update with the following:
- Average total charges – the typical amount of charges for that type of service
- Your Payer Specific Rate – the amount your insurance company agreed to pay for this service
- Minimum Negotiated Rate – the minimum amount BMC is contracted to receive for this service across all insurance companies
- Maximum Negotiated Rate – the maximum amount BMC is contracted to receive for this service across all insurance companies
- Uninsured Rate – the amount an uninsured patient is expected to pay for this service
- If you need any assistance please reach out to us at SelfPayInquiry@bmc.org
BMCHS Employee Group Medical Plans
In response to the Department of Health and Human Services, the Department of Labor, and the Department of the Treasury’s new Transparency in Coverage (TIC) rule, Health Plans Inc. has published machine readable files containing negotiated rates for all covered items and services for in-network providers as well as historical payments to, and billed charges from, out-of-network providers.